Continuous subcutaneous insulin infusion

Use of CSII requires care by skilled professionals, careful selection of patients, meticulous patient monitoring, and thorough patient education. Insulin pumps prescribed by a physician within these guidelines are a part of treatment and should be covered by the usual payment mechanisms.     

Continuous subcutaneous insulin infusion systems

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Dr Clarke has provided us with an excellent review of an exciting new development in the management of the diabetic who requires insulin. Maintaining better control and avoiding or minimizing late complications are, of course, the objectives. This discussion answers such questions as, What criteria must candidates for insulin pump therapy meet? How can potential problems—mechanical or physiologic—be avoided or minimized?     

胰岛素注射研究进展

胰岛素注射是内分泌科每天进行的一项技术操作 ,必须保持在每天的同一时间“同一部位”注射 ,如护理不当 ,将影响胰岛素的疗效 ,引起许多不良反应。因此 ,掌握胰岛素的分类及储存 ;选择合适的注射工具、部位、方法 ;了解治疗中的注意事项 ,对糖尿病治疗具有重要意义。胰岛素是最生理、最有效、副作用最小的治疗手段。一个国家 2型糖尿病患者使用胰岛素治疗的比例 ,反映其糖尿病治疗水平 ,现将胰岛素注射方面的护理研究介绍如下。胰岛素注射工具1 一次性 1ml注射器或玻璃注射器特点。该注射器针头与针管连接处存在 0 0 6～ 0 .10ml的死腔[1 …     

定时摇晃输液瓶 规范静脉输注胰岛素

[目的]探讨定时摇晃输液瓶,以规范静脉输注胰岛素的操作方法。[方法]取500mL 10％葡萄糖溶液玻璃瓶6瓶,分别在输液瓶中注入12U胰岛素摇匀,将各瓶挂于输液架上模拟人体输液过程,自然输注,滴速为50gtt／min,其中3瓶设为摇晃组,每隔10min摇晃1次,另外3瓶设为非摇晃组;每隔50mL（记录时间为20min）取液,采用紫外分光光度法测定液体中胰岛素浓度。[结果]摇晃组胰岛素浓度较为均匀,而非摇晃组胰岛素浓度发生明显变化。[结论]采取定时摇晃输液瓶的方法,规范静脉输注胰岛素可有效提高病人输注胰岛素的安全性。     

定时摇晃输液瓶规范静脉输注胰岛素

[目的]探讨定时摇晃输液瓶,以规范静脉输注胰岛素的操作方法.[方法]取500 mL10%葡萄糖溶液玻璃瓶6瓶,分别在输液瓶中注入12 U胰岛素摇匀,将各瓶挂于输液架上模拟人体输液过程,自然输注,滴速为50 gtt/min,其中3瓶设为摇晃组,每隔10min摇晃1次,另外3瓶设为非摇晃组;每隔50 mL(记录时间为20 min)取液.采用紫外分光光度法测定液体中胰岛素浓度.[结果]摇晃组胰岛素浓度较为均匀,而非摇晃组胰岛素浓度发生明显变化.[结论]采取定时摇晃输液瓶的方法,规范静脉输注胰岛素可有效提高病人输注胰岛素的安全性.     

Plasma insulin and C-peptide levels during continuous subcutaneous insulin infusion

A study was performed to estimate the absorption kinetics of insulin infused subcutaneously. Four insulin-dependent diabetic subjects had their insulin pumped through a subcutaneously implanted fine polyethylene catheter at a constant rate of 5.0 +/- 0.3 ml/h but at two different insulin concentrations: 218 mU/ml between meals, and 2400 mU/ml at the start of breakfast, lunch, and dinner (lasting 20, 30, and 30 min, respectively). The amount (40 U/day) and distribution of insulin delivered was identical in the four patients in order to facilitate comparison between the subjects. No attempt was made to normalize their blood glucose during the study period. A study of the kinetics of insulin absorption was made by assaying plasma insulin levels; lack of plasma anti-insulin antibodies was verified; plasma C-peptide levels were measured and were far below values observed in the fed state in nondiabetic patients. The mean maximum insulin level reached after switching from low to high concentration insulin was observed 87 +/- 2 min after breakfast, 117 +/- 22 min after lunch, and 125 +/- 20 min after dinner. Differences observed are not significant. These values are similar to those observed after subcutaneous injection of 40 U/ml Regular insulin as a single bolus. After switching from high to low concentration, plasma insulin levels did not return to their basal values before the third or fourth hour. Subcutaneous insulin infusion could be a safe and easy way of insulin administration in an open-loop system; however, this method does not seem to be suitable for a closed-loop system.     

Intravenous insulin infusion system to determine insulin regimen in diabetics

An algorithm for insulin infusion system to control blood glucose was derived from results of intravenous (i.v.) insulin infusion performed on 10 diabetics. I.v. insulin infusion was done on 14 diabetics for 24 hr using the algorithm, and blood glucose was controlled within the proper range in all cases; mean blood glucose was 130 +/- 42 mg/100 ml. During the examination, 4 of 14 cases did not need insulin infusion from midnight to the morning (type A) and 7 cases needed insulin infusion from midnight to the morning (type B). In 3 cases, insulin infusion was not needed at midnight, but blood glucose rose markedly in the early morning followed by insulin infusion (type C). The insulin regimen was determined according to the amount of insulin infused during the examination, dividing insulin dosages into two separate doses using semilente in the morning and a mixture of regular and lente insulin in the evening. In all the cases of type A and B, blood glucose was controlled well on the calculated regimen of insulin. However, good control of blood glucose was not obtained in 3 diabetics of type C. It is concluded that the algorithm is reliable in the estimation of the insulin infusion rate to control blood glucose in the diabetics, and the insulin regimen calculated from the result of intravenous insulin infusion is proper in about 78% of the diabetics.     

Subcutaneous insulin infusion: change in basal infusion rate has no immediate effect on insulin absorption rate

Eight insulin-dependent diabetic patients were simultaneously given subcutaneous infusions (1.12 IU/h each) of 125I-labeled Actrapid insulin in each side of the abdominal wall. After 24 h of infusion, the size of the infused insulin depots was measured by external counting for 5 h. The basal infusion rate was then doubled in one side and halved in the other for the next 4 h. Finally, 1.12 IU/h of insulin was given in both sides of the abdominal wall for an additional 3 h. The changes in the size of the depots were measured, and the absorption rates for each hour were calculated. During the first 5 h of infusion, the depot size was almost constant (approximately 5 IU) with an absorption rate that equaled the infusion rate. Doubling the infusion rate led to a significant increase in depot size, but the absorption rate remained unchanged for the first 3 h, and only thereafter was a significant increase seen. When the infusion rate was reduced to the initial 1.12 IU/h, the absorption rate remained elevated during the next 3 h. Correspondingly, when the infusion rate was decreased, the depot size also decreased, but the absorption rate remained unchanged for the first 3 h. The results show that a change in the basal insulin infusion rate does not lead to any immediate change in the insulin absorption rate. This should be considered when planning an insulin-infusion program that includes alteration(s) in the basal-rate setting.     

胰岛素泵与多次皮下注射胰岛素的临床效果比较

胆道铸型综合征（biliary cast syndrome，BCS）是肝移植术后（orthotopic liver transplantation，OLT）一种少见并发症，国内报道发生率达18％，发生机制尚不十分清楚，目前认为，由于供肝灌注不良及再灌注损伤，引起胆管内膜损伤，发生剥离甚至脱落，混合胆管内其他物质，在水分吸收后，固体成分沉积在胆道，铸成与胆管走向吻合的树状结构。现将137例原位肝移植术后17例并发BCS的临床观察与护理报道如下。     

持续皮下胰岛素输注与多次皮下胰岛素注射在2型糖尿病围手术期血糖控制疗效观察

目的 比较2型糖尿病围手术期应用持续皮下胰岛素输注(CSII)和多次皮下胰岛素注射(MSII)的血糖控制效果.方法 将外科疾病合并2型糖尿病患者180例随机分为2组,98例为CSII组(持续皮下胰岛素输注诺和灵R),82例为MSII组(多次皮下注射诺和灵R和诺和灵N,所用剂量根据患者不同情况而定),观察2组患者治疗前后不同时点的血糖变化、血糖达标时间、平均胰岛素用量、低血糖发生率、术后切口感染率及住院天数的变化.结果 CSII组治疗后各时点血糖控制及其其他相关指标均优于MSII组,即CSII组治疗后空腹血糖[(4.8±1.6)mmol/L]控制效果优于MSII组[(6.4±2.1)mmol/L](t=7.74,P<0.05);早餐后2 h血糖控制效果[(7.6±2.3)mmol/L]优于MSII组[(9.3±2.4)mmol/L](t=7.72,P<0.05);血糖迭标时间[(4.1±2.9)d]明显短于MSII组[(6.9±2.0)d](t=2.81,P<0.05);平均胰岛素用量[(40.7±10.3)U]明显少于MSII组[(63.2±17.0)U](t=3.57,P<0.05);低血糖发生率(9.20%)较MSII组(3.05%)低(χ~2=4.92,P<0.05);CSII组切口感染率(0.0%)较MSII组(10.9%)低(χ~2=4.18,P<0.05);住院天数[(15.3±7.2)d]明显短于MSII组[(22.5±9.7)d](t=3.12,P<0.05).结论 2型糖尿病患者在围手术期应用持续皮下胰岛素输注控制血糖迅速、有效、安全.     

Continuous insulin intravenous infusion therapy for VLBW infants

Very low birth weight (VLBW) infants less than 1,000 g often experience hyperkalemia and hyperglycemia during the initial hospital course. Hyperkalemia has been noted in 44% to 50% of infants less than 800 g birth weight or less than 28 to 29 weeks' gestation. Hyperglycemia occurs 18 times more frequently in infants less than 1,000 g than in those weighing more than 2,000 g. Insulin has been used for VLBW infants less than 1,000 g to manage hyperkalemia, control hyperglycemia, and optimize parenteral nutrition. A protocol for using exogenous insulin therapy for VLBW infants is described.     

Patient management of long-term continuous subcutaneous insulin infusion

AIM: This paper reports a study of patients' current practice with continuous subcutaneous insulin infusions, particularly with respect to the management of the pump. BACKGROUND: Successful implementation of continuous subcutaneous insulin infusion requires a motivated patient with a range of technical skills and self-management capabilities. The therapy should be prescribed, implemented and monitored by a skilled professional team familiar with it and capable of supporting the patient. METHODS: A questionnaire was mailed to 102 continuous subcutaneous insulin infusion treated patients at a Swedish university hospital with experience of pump treatment for at least 6 months. RESULTS: The questionnaire was answered by 88% of the patients, 53 women and 37 men, aged 22-71 years with a duration of continuous subcutaneous insulin infusion use of between 7 months and 19 years. The changing interval for soft infusion set ranged from 2.0 to 10.0 days (mean 4.8) and for metal needles from 1.5 to 7.5 days (mean 3.8), P = 0.001. Catheter occlusions were significantly more often reported in patients with presence of bleeding at the infusion site (P = 0.011) and among those using insulin lispro (P = 0.032). CONCLUSIONS: Patients having long-term continuous subcutaneous insulin infusion should be carefully audited with respect to the management of the insulin pump and its accessories. In patients who frequently experience problems, shorter intervals between changes of infusion sets are strongly advocated and type of insulin preparation may be of importance in some cases.